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Post-Polio Syndrome: Pathophysiology and Clinical Management
Anne Carrington Gawne and Lauro S. Halstead

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II. HISTORICAL BACKGROUND.

For more than 100 years, it has been recognized that new muscle weakness occurs in polio survivors many years after their initial illness. The first descriptions appeared in 1875 when four separate case histories were reported in the French literature by Carriere,[3] Raymond,[4] and Cornil and Lepine.[5] All of these patients were young men who had paralytic polio in infancy. They developed new weakness not only in previously affected muscles but also in muscles believed to be uninvolved. They all had physically demanding jobs and performed repetitive activities. In a commentary on one of the cases, Jean Martin Charcot suggested that a previous disease of the spinal cord may leave an individual more susceptible to a subsequent spinal disorder and that the new weakness was secondary to overuse of the involved limbs.[4] In a presentation to the Royal Society of Medicine in 1962, Zilkha reviewed 11 patients with motor neuron disease who developed progressive weakness 20 to 40 years later.[6] He stated "It could be suggested that the subsequent development of disease of the motor neuron in those patients with a previous history of poliomyelitis, usually 25 years before, is related to the occurrence of that earlier disease".

Since these initial reports, there have been other sporadic reports of similar phenomenon. In 35 reports of almost 250 cases, authors have described new problems, including weakness and fatigue occurring up to 71 years after the acute polio episode.[7] These neurological changes were most commonly diagnosed as a form of progressive muscular atrophy, chronic anterior poliomyelitis, late motor denervation, and forme fruste amyotrophic lateral sclerosis.[8,9] However, it was not until the early 1980s, approximately 40 years after the major epidemics of the 1940s and 1950s, that PPS became widely recognized.

As the numbers of persons experiencing these new symptoms increase, this subject has been studied in depth. This review concentrates on some of the more recent research. Although the incidence of acute poliomyelitis has decreased since the introduction of the Salk vaccine in 1955 and the Sabin trivalent oral polio vaccine (TOPV) in 1961, some of the principles learned through the study of PPS can be applied to other similar neurological diseases and aging with a disability.

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Created: 5th June 2000
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